Rosacea

What is Rosacea?

Rosacea is a common chronic inflammatory skin disease that affects the middle of the face. More than 16 million Americans suffer with rosacea and its negative impact on the quality of their lives. 50% of patients diagnosed with rosacea also have ocular rosacea. Women are more at risk than men, and men who develop rosacea tend to have more severe symptoms.

Most patients develop rosacea between ages 30 and 50. It is more common in fair skinned people who have blonde hair and blue eyes with a family history of rosacea or Celtic or Scandinavian ancestors. Still, rosacea can develop in any skin type and color.

Rosace is described by chronic recurrent flares and remissions. There is no cure, but medical treatments and lifestyle changes can control the symptoms.

What causes rosacea?

The cause is unknown; however, recent research suggests a complex combination of genetics, changes in the nervous system, immune system, vascular system and changes in the skin microbiome are involved. Environmental factors can trigger rosacea and aggravate it. A trigger can cause a flare up.

Certain known and potential triggers include: sun exposure, stress, intense physical exercise, diet, wind, hot and cold weather, spicy foods, alcohol, cinnamon, chocolate, tomatoes and citrus, hot tea and caffeine, and H. Pylori bacteria.

A microscopic skin mite called Demodex and the bacteria it carries are believed to be responsible for the flaring of rosacea and ocular rosacea. Demodex mites are a natural part of the skin microbiome. They live in the hair follicles on the face and the meibomian glands of the eyelids, and rosacea patients typically have an overgrowth of demodex mites.

Rosacea has been associated with various gastrointestinal diseases including inflammatory bowel disease, irritable bowel, Crohn’s disease, celiac disease, GERD, ulcerative colitis, Small Intestine Bacterial Overgrowth (SIBO), MS, type 1 diabetes and rheumatoid arthritis.

What are the symptoms of rosacea?

There are different types of rosacea based on the signs and symptoms:

• Type one, erythematotelangiectatic rosacea, is characterized by red areas on the face and sometimes visible blood vessels.
• Type two, papular rosacea, is characterized by bumps called papules and pus-filled spots called pustules.
• Type three, rhinophymatous rosacea, is characterized by thick, bumpy skin especially on the nose.
• Type four, occular rosacea, is characterized by inflamed and irritated eyes and eyelids.

Rosacea typically begins with flushing or redness and progresses to persistent redness and visible blood vessels on the nose, forehead, cheeks and chin.  Symptoms typically come and go and can flare for weeks or months before diminishing. The flushing and redness tend to remain.

Telangiectasia (“broken blood vessels”) or spider veins are common. Skin inflammation is found in the form of papules, and pustules that are often confused with acne. Additional symptoms include burning and stinging skin, dry skin, swelling, and eye involvement.

Ocular rosacea is characterized by watery or bloodshot eyes, a sensation of a foreign body in the eyes, burning, stinging, dryness, itching, light sensitivity, blurred vision and styes. Eye involvement can occur with or without a diagnosis of skin rosacea.

Plaques of thickened skin and enlarged pores are commonly found on the nose but can also affect the ears, chin and forehead. This type is more common in men.

How is rosacea diagnosed?

Diagnosis is based on the patient’s history and signs and symptoms, and a physical examination of the skin and eyes. There is no medical test. There are, however, some diseases that look like rosacea, so Dr. Michael Sotiriou may order testing to rule out these other diseases such as psoriasis, lupus or an allergic reaction.

How is rosacea treated?

Dr. Michael Sotiriou will spend time with you discussing how to identify triggers that cause flares or aggravate your rosacea. Once you learn your triggers you can avoid them with lifestyle changes. Sun protection is essential as we know that rosacea makes the skin sensitive to the sun. Finally, it is important to review your skin care products and habits to prevent irritation and flares.

Topical treatments for redness, visible blood vessels and rosacea acne include:

• Brimonidine (Mirvaso) the first FDA approved topical treatment specifically to treat the redness of rosacea.
• Oxymetazoline (Rhofade) may help reduce redness.
• Other drugs that can help improve redness and treat rosacea acne include Azelaic acid (Azelex or Finacea); Metronidazone (Metrogel) and ivermectin (Soolantra).

Oral antibiotics such as doxycycline can help to treat severe rosacea pustules and pimples.

Powerful acne drugs may be recommended in some cases. Beta blockers used to treat high blood pressure are sometimes ordered to treat visible blood vessels.

Laser treatments and intense pulsed light therapy can help reduce redness and the appearance of enlarged blood vessels, enlarged pores and thickened skin.

Dr. Sotiriou may recommend patients with eye involvement see an ophthalmologist for the treatment of ocular rosacea.  Blocked meibomian glands in the eyelids can be opened with warm compresses. Eyelid washes will keep the area clean. Moisturizing eyedrops help irritated eyes. Prescription antibiotic eye drops can kill the demodex mites and their bacteria, and topical sprays that contain hypochlorous acid help to control demodex mites.

Dr. Michael Sotiriou is a board-certified dermatologist at Salt Lake Dermatology & Aesthetics who finds fulfillment helping patients with their skin. Schedule a consultation to receive the correct diagnosis and treatment for your needs.